On Wednesday, July 29, U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) will hold a hearing on conflicts of interest in the fields of Continuing Medical Education (CME) and other medical research. As with many professions, physicians are required to participate in CME in order to maintain their license. In recent years, the pharmaceutical and medical device industries have increased their funding of CME, as well as other medical education programs, medical schools, and professional medical associations. The industries also pay physicians directly for their service as educational consultants. According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion between 1998 and 2006.

Click here to access the press release (and see the list of panel members)!

From the PLoS Medicine article "Can the Relationship between Doctors and Drug Companies Ever Be a Healthy One?":

But there is surely one thing we can all agree upon: both the pharmaceutical industry and health care professionals must focus on the goal of improving health. We seem to have lost sight of the shared aspirations between medical and pharmaceutical professionals. It is in everyone's interest that medicines are safe and effective. It is not credible to imply that health care professionals are easy victims to an industry that readily fools them with its marketing tactics. Many physician leaders find it condescending to be considered so malleable to “marketing exercises,” and it is offensive to suggest they cannot conduct an ethical exchange with industry. Despite strong differences between doctors and drug companies, now is surely a critical time to determine how to establish and nourish authentic alliances between these professionals....In my view the nascent moves towards disentanglement witnessed in recent years—in hospitals, universities, and professional associations—will only intensify, as new disclosure regimes attract even more public attention to these unhealthy relationships. Visits by “sexy” sales representatives, drug-sponsored continuing medical education, or scientific conferences in exotic locations could very quickly become laughable images of a bygone era.

Representative James P. Moran, Democrat of Virginia, is sponsoring a House bill that would ban ads for prescription sexual aids like Viagra and Levitra from prime-time television, on decency grounds. Representative Henry A. Waxman, Democrat of California, has said he favors empowering the Food and Drug Administration to bar consumer advertisements for new drugs for an initial period after the F.D.A. approves them — until there has been more real-world experience with the medications.

Meanwhile, Representative Jerrold Nadler, Democrat of New York, has introduced a bill called the Say No to Drug Ads Act. It would amend the federal tax code to prevent pharmaceutical companies from deducting the cost of direct-to-consumer drug advertisements as a business expense.

Thursday, July 23, 2009

With health care reform on the shelf until Congress reconvenes, will the health insurance industry start making any changes? From the Business Week article:

Karen Ignagni, president of the lobbying group America's Health Insurance Plans (AHIP), told Congress in a letter that a public plan would "significantly increase costs for those who remain in private coverage." ..."We do think comprehensive reform is needed," says Alissa Fox, senior vice-president of Blue Cross Blue Shield.

AHIP even launched an ad campaign on July 20 titled "Let's Fix Health Care," a far cry from the devastating "Harry and Louise" ads that helped sink reform efforts in the early 1990s. The ads call for a health-system overhaul but don't mention the public plan, which polls show the public supports. As Charles Boorady, health-care analyst with Citi Investment Research & Analysis, says: "The health insurers ... have a difficult PR battle."

According to a study of U.S. medical-cost patterns known as the Dartmouth Atlas of Health Care, chronically ill patients in the last two years of life cost Medicare $55,000 on average when they are treated at the Cleveland Clinic, tens of thousands of dollars less than at many highly-ranked academic medical centers.

"We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm," the president wrote in a letter to Sens. Edward Kennedy and Max Baucus last month. "We need to learn from their successes."

Studying a combination of factors can help explain why some kids are more likely to develop asthma than others, says Rob McConnell, lead author of the study published in the Proceedings of the National Academy of Sciences. "Childhood asthma is a complex disease, and probably has many contributing causes," he says. "This study provides another clue to what might be causing it."

The results also shed light on how risk factors such as stress can increase the vulnerability of the respiratory system to environmental pollution or allergens.

A state commission recommended yesterday that Massachusetts dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control exploding healthcare costs and improve the quality of care...the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person’s care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients’ care, which could improve quality and reduce costs.

Thursday, July 16, 2009

Former employees of certain medical-device makers allege in lawsuits unsealed in a Texas federal court that the companies paid kickbacks to heart surgeons to get the doctors to use their products to treat the heart-rhythm defect called atrial fibrillation....The case against Boston Scientific was filed by a former saleswoman who says she was fired after complaining about illegal practices at the company.

Thursday, July 09, 2009

In an interactive USA TODAY graphic, death rates and readmission rates can be easily calculated for heart attack, heart failure, and pneumonia (from more than 4,400 hospitals in the nation). The data comes from CMS, mid-2005 to 2008. Click here to access the interactive map. Click here to access Hospital Compare, CMS's website where one can compare hospitals (big surprise, huh?) on numerous process and outcome of care measures.

From Pauline Chen's article "When Doctors Make Mistakes" in the New York Times:

While doctors should strive for as few errors as possible, “you can’t go through training without making an error unless you are not taking care of patients,” Dr. West said. “And if you are really invested in the care of patients, there’s a personal cost when things don’t go well.”...Greater support for doctors from both the training process and patients could help to improve patient outcomes and strengthen the patient-doctor relationship. “In 21st century medicine, there’s no reason for a patient to accept suboptimal care,” Dr. West said. “At the same time, patients need to balance their expectations against the reality of the physician experience. And the medical establishment needs to do a better job of helping patients understand what physician lives are really like.”

The nation's hospitals will give up $155 billion in future Medicare and Medicaid payments to help defray the cost of President Barack Obama's health care plan, a concession the White House hopes will boost an overhaul effort that's hit a roadblock in Congress.

Vice President Joe Biden announced the deal at the White House on Wednesday, with administration officials and hospital administrators at his side.

"Reform is coming. It is on track; it is coming. We have tried for decades to fix a broken system, and we have never, in my entire tenure in public life, been this close," Biden said. And in a firm message to lawmakers, Biden added, "We must — and we will — enact reform by the end of August."

Tuesday, July 07, 2009

The WHO New Influenza A(H1N1) Clinical Checklist is intended for use by hospital staff treating a patient with a medically suspected or confirmed case of New Influenza A(H1N1). This checklist combines two aspects of care: i) clinical management of the individual patient and ii) infection control measures to limit the spread of New influenza A(H1N1).

The checklist is not intended to be comprehensive. Additions and modifications to fit local practice and circumstances are encouraged.